Acute diverticulitis of the cecum and ascending colon diagnosed by computed tomography

Abstract

Between June 1984 and August 1985, computed tomography (CT) was performed upon seven patients with diverticulitis of the cecum and ascending colon who presented with acute right lower quadrant symptoms of unknown origin. Three of these patients had undergone an appendectomy, while in the remaining four patients, the history and physical findings were atypical of acute appendicitis. CT findings suggestive of acute diverticulitis including thickening of the intestinal wall and pericolonic inflammation were present in all seven patients. In four patients, the colonic inflammation was limited to the segment of ascending colon superior to the ileocecal valve. In one patient, the inflammation involved both the ascending colon and the cecum, while in the two remaining patients, the inflammatory changes were limited to the cecum. An associated diverticular abscess was present in five patients and all were correctly identified preoperatively by CT. One patient in whom the diagnosis of uncomplicated diverticulitis of the ascending colon was made on the basis of the CT scan, was successfully managed nonoperatively with antibiotics. Five patients required a right hemicolectomy for perforated diverticulitis with abscess. The remaining patient underwent a right hemicolectomy for recurrent episodes of acute diverticulitis. Our experience suggests that CT is useful in the early diagnosis of diverticulitis of the cecum and ascending colon.